One of the pressing issues around the management of COVID-19 pandemic is the need to address vaccine hesitancy. Despite a robust public health campaign to promote confidence in available scientific recommendations about the safety and efficacy of the COVID-19 vaccines, a lot of Americans remain reluctant to take one.
Although ‘anti-vaxxers’ come from a variety of socio-economic and religious backgrounds, vaccine hesitancy is particularly hard to address among certain minority groups including African Americans. This is because in addition to the historical mistrust that exists between this group and the health system, African Americans on average have lower health literacy, poorer access to healthcare and receive lower quality of care as compared to other groups. As minority groups continue to be disproportionately affected by the pandemic, the need to bridge the information and trust gap in this group is quite literally a matter of life-or-death.
Research shows that clinicians are powerful influencers of health behavior, especially in the areas of vaccine acceptance among their patients. Unfortunately, most clinicians are not given enough time to engage patients in potentially life-saving health education about the COVID-19 pandemic or the vaccines that are available. The typical 15 to 20-minute clinic visit where clinicians address complex medical problems does not leave much time to engage a patient in a meaningful educational dialogue about the current pandemic. Scheduling patients for health education and engagement alone is not a reimbursable service by the majority of health insurers, even when we know this could save lives at this time.
Many clinicians offer printed handouts and refer their patients to resources such as the Centers for Disease Control (CDC) and other public health websites to get their questions answered. For some patients, who have good health literacy (defined as “The degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”) this may be sufficient. For many patients who have poor health literacy, complex information delivered in the absence of a dialogue with a trusted healthcare worker has the potential to worsen the confusion and distrust.
Yes, health education does not need to be delivered by a physician or an advanced health care practitioner, but these healthcare workers are important players in patient engagement and health behavior change. Every time a patient who comes into a healthcare facility leaves without being engaged in educational conversation about the pandemic, we are losing the opportunity to mitigate vaccine hesitancy.
Divorcing the preventive arm of healthcare from that of the curative at the time of a pandemic is a missed opportunity to save lives. Our inability to deliver care to fit the needs of our patient population, especially the vulnerable, and our insistence on keeping the false dichotomy between medicine and public health are some of the main reasons why we have a very expensive, inequitable and in many ways ineffective healthcare system in the United States.
According to cost analysis done by FAIR Health, an independent non-profit organization that keeps track of national health data, the average cost of hospital care for COVID-19 patients without insurance ranges between $51,389 to $78,569 depending on age group. Patient engagement and health education during clinical encounters should be part of our larger strategy to save lives and can be done at a fraction of the cost of hospital care. The current health policy agenda should explore ways we can integrate public health efforts with clinical services and align reimbursements to reflect the importance of this approach in the lives of the vulnerable among us.
Sosena Kebede MD, MPH. The views and opinions expressed here are my own and do not reflect the views and opinions of the organization for which I work.